TITLE XXXVII
INSURANCE

CHAPTER 420-G
PORTABILITY, AVAILABILITY, AND RENEWABILITY OF HEALTH COVERAGE

Section 420-G:9

    420-G:9 Minimum Participation Requirements. –
I. A health carrier may not require more than the minimum participation percentage of the employees eligible for health coverage in a small employer group to participate in the health carrier's health coverage plan. The minimum participation percentage shall be 75 percent when the health carrier's plan is the sole health coverage plan being sponsored by the employer group, and 37.5 percent when the health carrier's plan is not the sole health coverage plan being sponsored by the employer group.
II. For the purpose of calculating whether or not a small employer group's enrollment meets a carrier's minimum participation requirements:
(a) Any full-time or part-time employees who are covered as a dependent on another person's health coverage shall be excluded from the count.
(b) The total number of full-time employees and part-time employees who are otherwise eligible for health coverage shall be counted.
III. The minimum participation requirements shall be calculated on an employer-by-employer basis if the small employer is part of an association, trust, or other similar arrangement.
IV. In performing the computation to determine the actual enrollment necessary to meet the minimum participation requirement as a small employer group, the health carrier shall round any fractional number to the higher integer.
V. For the purpose of calculating whether or not a small employer group's enrollment meets a carrier's minimum participation requirements:
(a) Any full-time or part-time employee who is covered as a dependent on another person's health coverage or is enrolled in a governmental plan such as Medicare, Medicaid, or TRICARE shall be excluded from the count.
(b) Any full-time or part-time employee who has been found eligible for a premium tax credit and is enrolled in a qualified health plan (QHP) purchased through an exchange shall be excluded from the count.
(c) The total number of full-time employees and part-time employees who are otherwise eligible for health coverage shall be counted.
VI. The requirements under this section shall be the only participation requirements. Minimum employer contributions, or other criteria, shall not be permitted.

Source. 1997, 344:1. 1998, 340:15, eff. Aug. 25, 1998. 2019, 220:10, eff. Sept. 10, 2019.